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      Clinical features and treatment of inflammatory bowel disease in a low-incidence area : A hospital-based retrospective cohort study in Taiwan

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          Abstract

          Inflammatory bowel disease (IBD) has emerged in the Asia–Pacific area over the past 2 decades. There is a paucity of clinical data regarding real-world experience of patients with IBD from low endemic area such as Taiwan. Therefore, the present study aimed to review the clinical features of patients with IBD form a tertiary center from Taiwan.

          A total of 163 patients with IBD were identified from the electronic clinical database of Changhua Christian Hospital. Demographic data of the patients and clinical features of the disease pattern were retrospectively reviewed.

          There was a higher proportion (62.6%) of patients diagnosed with ulcerative colitis (UC). Patients with Crohn disease (CD) and UC had male predominance. The median age of diagnosis was younger in patients with CD than in patients with UC (CD vs UC: 31 vs 40 years, P = .0423). The disease distribution of UC was as follows: E1 (15.7%), E2 (47.1%), and E3 (37.3%). The disease distribution of CD was as follows: L1 (36.1%), L2 (14.8%), L3 (42.6%), and L4 (6.5%). The majority of patients with CD had a complicated presentation with B2 (32.8%) and B3 (32.8%). Patients with CD had a higher bowel resection rate than patients with UC. Patients with CD were more likely to be treated with immunomodulator and biologics and those with UC were more likely to be treated with 5-aminosalicylic acid (5-ASA). A trend of decreased bowel resection for patients with IBD and less severe phenotype of patients with CD were observed after 2015.

          UC with male predominance was the predominant type of IBD in the study. Patients with CD are likely to have a complicated disease course, requiring a higher demand of biologic therapy than patients with UC.

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          ACG Clinical Guideline

          Ulcerative colitis (UC) is an idiopathic inflammatory disorder. These guidelines indicate the preferred approach to the management of adults with UC and represent the official practice recommendations of the American College of Gastroenterology. The scientific evidence for these guidelines was evaluated using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) process. In instances where the evidence was not appropriate for GRADE, but there was consensus of significant clinical merit, "key concept" statements were developed using expert consensus. These guidelines are meant to be broadly applicable and should be viewed as the preferred, but not only, approach to clinical scenarios.
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            The epidemiology of inflammatory bowel disease: East meets west

            The incidence of inflammatory bowel diseases (IBD) in East has risen over the past decade to become a global disease. The increasing number of studies on the incidence and course of IBD in East has enabled us to explore East versus West differences in the epidemiology of IBD which could enhance our understanding of the heterogeneity of the disease and eventually assist in the discovery of novel therapeutic targets and design of preventive strategies. Comparison of population-based data in East and West reveals that the incidence of IBD has risen rapidly in East while plateauing in West. Furthermore, the clinical presentation and course of IBD differs between East and West with more patients in East presenting with complicated disease. Considering the scarcity of population-based data from East and the lack of studies with long durations of follow-up, it remains to be clarified whether these differences reflect true differences in disease presentation. The effects of genetic and environmental risk factors contributing to IBD also differ between Eastern and Western populations. Considering the differential effects of genetic and environmental risk factors in East and West, future studies should seek to discover novel genetic and environmental risk factors which might specifically apply to eastern populations. In this narrative review, we compare the epidemiology of IBD between eastern and western countries by summarizing evidence from population-based cohort studies in the last ten years. Furthermore, we look at differences in genetic susceptibility and environmental triggers of IBD between East and West.
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              Sex-Based Differences in Incidence of Inflammatory Bowel Diseases—Pooled Analysis of Population-Based Studies From Western Countries

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                Author and article information

                Journal
                Medicine (Baltimore)
                Medicine (Baltimore)
                MEDI
                Medicine
                Lippincott Williams & Wilkins (Hagerstown, MD )
                0025-7974
                1536-5964
                12 March 2021
                12 March 2021
                : 100
                : 10
                : e25090
                Affiliations
                [a ]Division of Gastroenterology, Department of Internal Medicine, Changhua Christian Hospital
                [b ]Institute of Medicine, Chung Shan Medical University, Taichung
                [c ]General Education Center
                [d ]Department of Tumor Center, Changhua Christian Hospital
                [e ]Department of Information Management, Chien-Kuo Technology University, Chunghua, Taiwan.
                Author notes
                []Correspondence: Hsu-Heng Yen, Division of Gastroenterology, Department of Internal Medicine, Changhua Christian Hospital, Changhua, Taiwan (e-mail: 91646cch.org.tw, blaneyen@ 123456gmail.com ).
                Author information
                http://orcid.org/0000-0002-3494-2245
                Article
                MD-D-20-05097 25090
                10.1097/MD.0000000000025090
                7969237
                33725901
                2a2d2e74-217e-4300-9245-e29c87a39204
                Copyright © 2021 the Author(s). Published by Wolters Kluwer Health, Inc.

                This is an open access article distributed under the terms of the Creative Commons Attribution-Non Commercial License 4.0 (CCBY-NC), where it is permissible to download, share, remix, transform, and buildup the work provided it is properly cited. The work cannot be used commercially without permission from the journal. http://creativecommons.org/licenses/by-nc/4.0

                History
                : 29 May 2020
                : 14 January 2021
                : 17 February 2021
                Funding
                Funded by: Changhua Christian Hospital
                Award ID: 108-CCH-IRP-018 and 109-CCH-IRP-008
                Award Recipient : Hsu-Heng Yen
                Categories
                4500
                Research Article
                Observational Study
                Custom metadata
                TRUE

                crohn disease,inflammatory bowel disease,ulcerative colitis

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